CS Form No.
7 Republic of the Philippines
Series of 2018 DEPARTMENT OF EDUCATION
Region IV-CALABARZON
SCHOOLS DIVISION OF LAGUNA
CLEARANCE FORM
I PURPOSE
July 8, 2020
Date of Application
TO: DEPARTMENT OF EDUCATION
(Agency Name)
I hereby apply for clearance from money, property and work-related accountabilities for:
Purpose: ✘ Transfer Resignation Other Mode of Separation:
Retirement Leave Please specify:
Effectivity/Inclusive Period: July 8, 2020
Plaridel Integrated National High School
Office of Assignment: District of Nagcarlan, Division of Laguna
ERVIN C. REYES
Position/SG/Step: Master Teacher 2/ 19 / 2 Name and Signature of Employee
II CLEARANCE FROM WORK-RELATED ACCOUNTABILITIES
We hereby certify that this applicant is cleared of work-related accountabilities from this Unit/Office/Dept.
ROMEO M. SULIGUIN, EdD GREGORIA B. GUTIERREZ, EdD
Principal II District Supervisor
Immediate Supervisor Head of Office
III CLEARANCE FROM MONEY AND PROPERTY ACCOUNTABILITIES
Not
Name of Unit/Office/Department Cleared Cleared
Name of Clearing Officer/Official Signature
1. Administration Sector
Supply and Property Procurement and Management ESTRELLA B. DELOS SANTOS
a. Services Administrative Officer IV
LOURDES M. FRESNIDO
b. Human Resource Welfare & Assistance Administrative Officer IV
c. Agency-accredited Union/Cooperative N/A
2. Library
N/A
a. Legal Office Library
N/A
b. Library Services
3. Finance and Assets Management
IRENE A. FERNANDEZ
a. Financial Services Accountant III
IRENE A. FERNANDEZ
b. Transaction, Processing & Billing Services Accountant III
IRENE A. FERNANDEZ
c. Payroll & Remittance Services Accountant III
4. Professional and Institutional Development
a. Scholarship Services
IV CERTIFICATION OF NO PENDING ADMINISTRATIVE CASE:
a. Internal Affairs Office/Legal Affairs Office
with pending administrative case
with ongoing investigation (no formal charge yet)
V CERTIFICATION
MARITES A. IBAÑEZ, CESO V
Signature over Printed Name of Agency Head
Page 1 of 2
CS Form No. 7 Republic of the Philippines
Series of 2018 DEPARTMENT OF EDUCATION
Region IV-CALABARZON
SCHOOLS DIVISION OF LAGUNA
CLEARANCE FORM
I PURPOSE
July 8, 2020
Date of Application
TO: DEPARTMENT OF EDUCATION
(Agency Name)
I hereby apply for clearance from money, property and work-related accountabilities for:
Purpose: ✘ Transfer Resignation Other Mode of Separation:
Retirement Leave Please specify:
Effectivity/Inclusive Period: July 8, 2020
Plaridel Integrated National High School
Office of Assignment: District of Nagcarlan, Division of Laguna
ERVIN C. REYES
Position/SG/Step: Master Teacher II / 19 / 2 Name and Signature of Employee
II CLEARANCE FROM WORK-RELATED ACCOUNTABILITIES
We hereby certify that this applicant is cleared of work-related accountabilities from this Unit/Office/Dept.
ROMEO M. SULIGUIN, EdD GREGORIA B. GUTIERREZ, EdD
Principal II District Supervisor
Immediate Supervisor Head of Office
III CLEARANCE FROM MONEY AND PROPERTY ACCOUNTABILITIES
Not
Name of Unit/Office/Department Cleared Cleared
Name of Clearing Officer/Official Signature
1. Administration Sector
Supply and Property Procurement and Management FLORDELYN M. GONZALES
a. Services Teacher I - School Property Custodian
MARIAN B. VERGARA
b. Human Resource Welfare & Assistance Teacher III - School Guidance Councilor
c. Agency-accredited Union/Cooperative N/A
2. Library
N/A
a. Legal Office Library
N/A
b. Library Services
3. Finance and Assets Management
EMMA E. PONTEPEDRA
a. Financial Services Teacher II - School Treasurer
b. Transaction, Processing & Billing Services N/A
c. Payroll & Remittance Services N/A
4. Professional and Institutional Development
a. Scholarship Services
IV CERTIFICATION OF NO PENDING ADMINISTRATIVE CASE:
a. Internal Affairs Office/Legal Affairs Office
with pending administrative case
with ongoing investigation (no formal charge yet)
V CERTIFICATION
GREGORIA B. GUTIERREZ, EdD
District Supervisor
Signature over Printed Name of Agency Head
Page 1 of 2
INSTRUCTIONS:
1. Employees who are retiring, being separated, transferring to other agencies,
leaving the Philippines and going on maternity leave of absence shall prepare
this form in quadruplicate.
2. This clearance should be duly accomplished before paying the last salary or
any money due the employees. (Specify which type of clearance: maternity
leave, retirement, transfer, etc.)
3. If the employees are cleared from a unit/office/department, the
clearing/authorized official may attach to this clearance the pertinent
document/s that shall prove that the employees are cleared of any obligation
or accountability from their office, if any, and tick the box under the "Cleared"
column before affixing their signatures.
4. If the employees appear to have uncleared accountability/ies from a
unit/office/department, the clearing/authorized official shall attach to this
clearance the pertinent document/s that shall prove that the employees have
remaining obligation or accountability from their office further indicating the
necessary action/s that the employee must satisfy in order to be cleared, and
tick the box under the "Uncleared" column. The clearing/authorized official
must only sign this clearance corresponding to their name once the employee
have complied the necessary requirements and cleared of all the obligation/s
and accountability/ies from their office. They must also tick the box under the
"Cleared" column.
5. The HRMO shall distribute copies of approved clearance as follows: original to
the employee; duplicate to be attached to the payroll or voucher; triplicate to
human resource unit file; and fourth copy to accounting/auditing office.
6. Processing of clearance certificate shall follow the order of number indicated.
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